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EPWorth Sleepiness Scale Form Corporate

Instructions: Be as truthful as possible.

Name*
FirstLast
Phone*
Email*
Company*
Sitting and Reading*
- Would never doze
- Slight chance of dozing
- Moderate chance of dozing
- High chance of dozing
Watching Television*
- Would never doze
- Slight chance of dozing
- Moderate chance of dozing
- High chance of dozing
Sitting inactive in a public place, for example, a theater or a meeting*
- Would never doze
- Slight chance of dozing
- Moderate chance of dozing
- High chance of dozing
As a passenger in a car for an hour without a break*
- Would never doze
- Slight chance of dozing
- Moderate chance of dozing
- High chance of dozing
Lying down to rest in the afternoon*
- Would never doze
- Slight chance of dozing
- Moderate chance of dozing
- High chance of dozing
Sitting quietly after lunch when you’ve had no alcohol*
- Would never doze
- Slight chance of dozing
- Moderate chance of dozing
- High chance of dozing
In a car while stopped in traffic*
- Would never doze
- Slight chance of dozing
- Moderate chance of dozing
- High chance of dozing

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